We report a case of spontaneous coronary artery dissection located next to a myocardial bridge in a patient with concomitant takotsubo cardiomyopathy. A fusion image with multidetector-row computed tomography and single-photon emission computed tomography played an important role in the diagnosis of these lesions. (Level of Difficulty: Advanced.)
An 80-year-old man with exertional dyspnea underwent coronary angiography (CAG) with iomeprol.His resting electrocardiogram (ECG) showed J-waves in inferior leads and no Brugada pattern (Picture A).Right CAG (RCAG) was performed, as the left CAG findings were normal (Picture B, D).We observed premature ventricular contraction and significant J-wave amplitude (Picture C), followed by ventricular fibrillation (VF) after the first RCAG injection.Catheter manipulation and super-selective intubation were excluded as possible causes.J-waves are occasionally observed during CAG.Local conduction delays cause J-wave induction and augmentation after contrast medium administration, especially after RCAG (1).Contrast-induced J-wave augmentation rarely causes VF in patients with resting-ECG J-waves.Kariki et al. reported a case with J-wave augmentation and VF during bilateral CAG (2).Contrast-induced myocardial toxicity cannot be dismissed; however, the extent to which resting J-waves are a risk factor for VF remains unclear.Nonetheless, their presence during CAG must be noted.
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